Provider Demographics
NPI:1790906246
Name:ULVELING, KYLE GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:GERARD
Last Name:ULVELING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3065
Mailing Address - Country:US
Mailing Address - Phone:712-792-6500
Mailing Address - Fax:712-792-0908
Practice Address - Street 1:405 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3065
Practice Address - Country:US
Practice Address - Phone:712-792-6500
Practice Address - Fax:515-246-4481
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine